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Guide for the Perplexed

Let’s say you’re generally a moderate voter. You look at the Romney-Ryan ticket and see that they are much more conservative than you. They don’t believe in tax increases ever. You think tax increases have to be a part of a budget deal. They want to slash social spending to the bone. You think that would be harsh on the vulnerable and bad for social cohesion.

You look at the Obama-Biden ticket. You like them personally. But you’re not sure what they want to achieve over the next four years. The country needs big changes, and they don’t seem to be offering many. Where’s the leadership?

In this disaffected frame of mind, you ask yourself: What really matters in this election? Well, the big issue is national decline. How can we ensure that the U.S. is as dynamic in the 21st century as it was in the 20th?

The biggest threat to national dynamism is spending money on the wrong things. If you go back and look at the federal budgets during the mid-20th century, you see that they spent money on the future — on programs like NASA, infrastructure projects, child welfare, research and technology. Today, we spend most of our money on the present — on tax loopholes and health care for people over 65.

A study by Jessica Perez and others at the group Third Way lays out the basic facts. In 1962, 14 cents of every federal dollar not going to interest payments were spent on entitlement programs. Today, 47 percent of every dollar is spent on entitlements. By 2030, 61 cents of every noninterest dollar will be spent on entitlements.

Entitlement spending is crowding out spending on investments in our children and on infrastructure. This spending is threatening national bankruptcy. It’s increasing so quickly that there is no tax increase imaginable that could conceivably cover it. And, these days, the real entitlement problem is Medicare.

So when you think about the election this way, the crucial question is: Which candidate can slow the explosion of entitlement spending so we can devote more resources toward our future?

Looking at the candidates through this prism, you see that President Obama deserves some credit for taking on entitlement spending. He had the courage to chop roughly $700 billion out of Medicare reimbursements. He had the courage to put some Medicare eligibility reforms on the table in his negotiations with Republicans. He created that (highly circumscribed) board of technocrats who might wring some efficiencies out of the system.

Photo

David BrooksCredit
Josh Haner/The New York Times

Still, you wouldn’t call Obama a passionate reformer. He’s trimmed on the edges of entitlements. He’s not done anything that might fundamentally alter their ruinous course.

When you look at Mitt Romney through this prism, you see surprising passion. By picking Paul Ryan as his running mate, Romney has put Medicare at the center of the national debate. Possibly for the first time, he has done something politically perilous. He has made it clear that restructuring Medicare will be a high priority.

This is impressive. If you believe entitlement reform is essential for national solvency, then Romney-Ryan is the only train leaving the station.

Moreover, when you look at the Medicare reform package Romney and Ryan have proposed, you find yourself a little surprised. You think of them of as free-market purists, but this proposal features heavy government activism, flexibility and rampant pragmatism.

The federal government would define a package of mandatory health benefits. Private insurers and an agency akin to the current public Medicare system would submit bids to provide coverage for those benefits. The government would give senior citizens a payment equal to the second lowest bid in each region to buy insurance.

This system would provide a basic health safety net. It would also unleash a process of discovery. If the current Medicare structure proves most efficient, then it would dominate the market. If private insurers proved more efficient, they would dominate. Either way, we would find the best way to control Medicare costs. Either way, the burden for paying for basic health care would fall on the government, not on older Americans. (Much of the Democratic criticism on this point is based on an earlier, obsolete version of the proposal.)

You’re still deeply uncomfortable with many other Romney-Ryan proposals. But first things first. The priority in this election is to get a leader who can get Medicare costs under control. Then we can argue about everything else. Right now, Romney’s more likely to do this.

All of which causes you to look over to the Democrats and wonder: Why don’t they have an alternative? Silently, a voice in your head is pleading with them: Put up or shut up.

If Democrats can’t come up with an alternative on this most crucial issue, how can they promise to lead a dynamic growing nation?

Joe Nocera is off today.

A version of this op-ed appears in print on August 21, 2012, on page A19 of the New York edition with the headline: Guide For the Perplexed. Today's Paper|Subscribe